Bullectomy

What is a bullectomy?
Why do I need a bullectomy?
What are the risks of having a bullectomy?
How do I prepare for a bullectomy?
What happens during a bullectomy?
What happens after a bullectomy?

What is a bullectomy?

A bullectomy is surgery to remove air pockets in the lungs. This procedure can help the lungs to work better.

Why do I need a bullectomy?

In some people, the tiny air sacs that transfer oxygen from the lungs into the blood, called alveoli, become damaged and form air pockets.

These air pockets eventually thin out and look like thin-walled balloons in the lung tissue.

Known as bullae, the balloons grow and compress the lung, making it hard to breathe.

If bullae rupture, air escapes into the space between the lung and the chest wall, which can cause the lung to collapse (pneumothorax).

A pneumothorax is a serious problem that causes shortness of breath and chest pain. A chest tube can be inserted into the lung to allow the lung to re-expand again.

If you have bullae, a bullectomy can make it easier to breathe and reduce the risk of complications.

Your doctor will consider the size and location of the bullae, and your overall health status, to determine if this surgery is suitable for you.

Other conditions that are associated with the development of bullae and may require a bullectomy include:

• Marfan syndrome
• Sarcoidosis
• Smoking and COPD.

When bullae are removed, the healthier parts of your lungs can work better, and your breathing will improve.

Many young, otherwise healthy non-smokers can also develop bullae without any risk factors. Bullae are mostly present in people who have a pneumothorax. After a bullectomy, the bullae don’t normally recur.

What are the risks of having a bullectomy?

As with any type of surgery, a bullectomy carries some risks. Your doctor will talk to you about the risks before you agree to have surgery.

Generally, risks are uncommon and can include:

• Bleeding – excess bleeding is uncommon but possible with any type of lung surgery
• Infection – physiotherapy and antibiotics are always used after surgery to prevent lung and wound infections, but there is still a risk. Contact your doctor if you feel unwell after the surgery and experience fever, chest pain, coughing up blood, or oozing wounds
• Pain – it is normal to have some discomfort after the operation, though this normally gets better after the chest tube is removed; you should be able to breathe freely and cough, so if you are in pain, speak to your medical team who are there to make sure you are comfortable
• Prolonged air leak – a small amount of air may leak out (if this happens, the chest drain may need to remain until the air leak stops which can take more than seven days).

How do I prepare for a bullectomy?

To have a bullectomy, you need to be physically strong enough for the surgery. Your doctor will decide if this surgery is suitable for you by performing a series of tests, which may include:

• Blood tests – in particular, arterial blood gas tests
• Chest CT scan – to take detailed pictures of your lungs
• Chest X-ray – to take images of the inside of your chest
• Lung function tests – to see how well your lungs are working.

Around two weeks before your surgery:

• Be reviewed by a cardiologist – a specialist will check that your heart is safe for the surgery
• Check with your doctor about taking your medications – you may need to stop taking some medications before your surgery, such as blood thinners (your doctor will talk to you about this)
• Stop smoking – speak to your doctor if you need help, or phone 13QUIT to get started.

If you take SGLT2 medicine for diabetes, you will need to stop taking them at least 3 days before your surgery; read our Patient Information Guide on SGLT2 inhibitors for diabetes.

• Have some important tests – you will need an ECG, chest X-ray, blood tests, lung function tests, cardiac stress test, and nose and groin swabs
• Plan your transport home – it is your responsibility to arrange transport home; for information, including guidelines and tips for travelling home by car or plane after lung surgery, visit our travel page
• Prepare your home for your return from hospital – make sure you have someone to collect you from hospital, take you home, and help you with shopping, meals, cleaning and driving
• Shower with antibacterial soap (from a chemist) daily before coming into hospital – your doctor will recommend a suitable soap brand for you.

On the day before surgery:

• Ensure your bowels are opened – ask your doctor for a laxative, if needed
• Pack a small bag of essentials, like toiletries and glasses – your bag of essentials will be taken to the Intensive Care Unit after your surgery
• Stop eating and drinking – you’ll need to fast from midnight before your surgery.

On the day of your surgery:

• A member of hospital staff will clip off any hair from your chest – this is done to reduce the potential of infection
• Remember not to eat or drink anything – you’ll need to keep fasting, and talk to your doctor if you have any questions about this
• Wear a hospital gown – you’ll also need to remove any makeup, nail polish and jewellery (dentures can be left in).

What happens during a bullectomy?

A bullectomy can be done in two ways:

• Thoracotomy – open-chest surgery, where a 15-20cm cut between your ribs to operate
• Video assisted thoracoscopic surgery (VATS) – minimally invasive surgery performed through tiny cuts of 3-4cm.

Your doctor will recommend the most suitable approach based on the location and size of the bullae.

For both techniques, you will be given a general anaesthetic.

When the bullectomy is finished, the cuts are closed with stitches. Your doctor will insert a tube into your chest to drain air and fluids which helps your recovery.

What happens after a bullectomy?

After your surgery, you will be taken to a Recovery Room or Intensive Care Unit in the hospital for close monitoring.

Once the staff are happy with your progress, you’ll be transferred to a hospital ward.

During this time:

• Your oxygen will need to stay on for at least the first few hours
• Your chest drain normally stays in for 2-3 days, depending on the amount of chest drainage and whether there is an air leak
• You may have a tube in your bladder to measure your urine (this is normally taken out the following morning after surgery).

While in hospital, you’ll see a physiotherapist regularly to help with your breathing, exercising, infection prevention and general recovery.

Other points to be aware of as you recover in hospital include:

• Breathing – you can expect to feel short of breath for 4-5 days after the operation as your lungs recover, but your breathing will improve
• Eating and drinking – you will be able to eat and drink the day after your surgery
• Pain relief – you’ll be given pain relief regularly, and hospital nurses will monitor your pain levels (tell them if you are still in pain after taking medication)
• Showering – you will need help with showering, and your hospital staff will assist with this.

Expect to stay in hospital for 3-7 days, depending on the technique used for the surgery. Try not to compare yourself to others and don’t worry if you need longer.

When it’s time to leave hospital, your doctor and hospital staff will help ensure you have everything you need for a healthy recovery at home.

Here’s what you need to know about returning home after your bullectomy:

• Diet – it’s common to have a poor appetite initially, so stick to small frequent meals and make sure you have enough to drink
• Driving – you will usually be able to drive 2-4 weeks after your surgery, but always check with your doctor first
• Follow up appointments – you will need to make appointments to see your:
• GP – one week after you leave hospital
• Oncologist – two weeks after surgery
• Surgeon – six weeks after surgery
• Pulmonary rehab – you can expect a fairly gradual recovery for the first few weeks (you’ll probably start feeling ‘normal’ around 4-6 weeks after surgery); we encourage you to attend a pulmonary rehabilitation program to assist with your recovery
• Rest – it’s normal to feel very tired for at least the first week, so try to have several rest periods during the day
• Support – you will need someone to be at home with you for the first few days to help with lifting (shopping, washing, vacuuming, making beds)
• Test results – the results from your tests will be available around one week after your surgery, and your doctor will contact you to discuss this
• Work – you may need 2-4 weeks or longer off work, so discuss your work plans with your doctor and ask for a medical certificate if needed
• Wound care – be aware of the following points:
  • Your wounds can take up to four weeks to heal
  • Your stitches will need to be removed 12 days after surgery by your GP
  • You may shower daily and get the wounds wet, but do not soak the wounds; gently pat your wounds dry and avoid using any creams or powder
  • You may have some numbness, tingling or pins and needles around your wounds for up to a few month
  • Some inflammation around your wound is common, and you’ll be given antibiotics to prevent infection.

After bullae are removed, your breathing will improve. Some of your COPD symptoms may also be less noticeable.

If you notice your wounds becoming red or oozy, or if you have any concerns about your wound healing, please contact your GP or surgeon as soon as possible.